Alpha Cell Dysfunction: Why Your Blood Sugar Rises When You Didn’t Eat

“If you wake up higher than you went to bed, blame alpha cells, not midnight snacks.”

Welcome back to the Diabetes Podcast blog! Today, we’re wrapping up the “ominous octet” with a simple but powerful topic: alpha cell dysfunction. We call it “glucagon gone rogue.”

If you’ve ever gone to bed with a lower blood sugar and woke up higher—even without eating—this is for you. We’ll explain what alpha cells do, what goes wrong in type 2 diabetes, how medications help, and how food and movement bring things back in line. Clear, practical, and doable.

What Alpha Cells Do (In a Healthy Body)

• Alpha cells live in your pancreas.

• Their job: release a hormone called glucagon.

• Glucagon tells your liver to release stored glucose (glycogen) or make new glucose.

• This protects you during fasting, exercise, and lows. Think of a seesaw:

  • Insulin goes up after meals.

  • Glucagon goes down after meals.

  • Together they keep glucose homeostasis (steady blood sugar).

What Goes Wrong: Alpha Cell Dysfunction

In type 2 diabetes, alpha cells stop listening well to insulin and glucose. They become “resistant” to the normal “turn down” signal.

What that looks like:

• After a meal, insulin should rise and glucagon should drop. But instead, glucagon stays high.

• Your liver keeps pumping out glucose even when your blood sugar is already high.

• It’s like pressing the gas and the brake at the same time. Confusing for your liver. Bad for your numbers.

Where This Shows Up on the Timeline

• Early: You can have insulin resistance with normal glucose. A fasting insulin lab can catch this.

• Impaired glucose tolerance (post-meal highs): alpha cell dysfunction begins. Glucagon suppression after meals is blunted.

• Impaired fasting glucose: the liver overproduces glucose overnight; fasting numbers climb.

• Type 2 diabetes: fasting ≥126 mg/dL or random ≥200 mg/dL with symptoms.

Bottom line: By the time you have prediabetes or type 2 diabetes, alpha cell dysfunction is usually there. The liver often “sabotages” your efforts by releasing glucose when you don’t need it.

Medications That Help Alpha Cell Dysfunction

GLP-1 receptor agonists: Ozempic, Trulicity, Mounjaro; weight loss doses include Wegovy and Zepbound.

• How they help: reduce glucagon when glucose is high, not when low (glucose-dependent).

• Common side effects: nausea, vomiting, diarrhea.

• Do not use with a personal or family history of medullary thyroid C cell tumors.

DPP-4 inhibitors: like Januvia.

• How they help: prevent breakdown of your own GLP-1, which then reduces glucagon after meals.

• Best earlier in the disease. Generally safe.

• Do not combine with a GLP-1 RA (same pathway, different step).

SGLT-2 inhibitors:

• May help overall glucose, but effects on glucagon are mixed in studies.

• Could still be part of the plan for the right person.

Food Strategies To Tame Alpha Cell Dysfunction

Focus on slowing digestion and avoiding sharp spikes:

Choose fiber-rich, minimally processed carbs:

• Beans and lentils.

• Non-starchy veggies: broccoli, cauliflower, bell peppers, leafy greens, cucumbers, zucchini, mushrooms, tomatoes, etc.

Choose intact whole grains:

• Look for “whole wheat flour” or “whole grain” as the first ingredient.

• Oats count; steel-cut or slow-cook oats are best for steadier glucose.

Pair carbs with protein and healthy fats:

• Example: oats + Greek yogurt + walnuts; beans + avocado; whole grain toast + eggs.

Limit refined grains and added sugars:

• White flour products, sugary drinks, sweetened yogurts, pastries. These trigger fast spikes and worsen the insulin–glucagon mismatch.

Cooked vs. raw veggies?

• Cooking is not “bad processing.” Some veggies are better cooked for nutrient access.

• Eat them the way you’ll actually eat them. Consistency beats perfection.

Movement That Helps Your Liver Listen Again

All movement you’ve heard us recommend still applies here—and it hits multiple defects at once.

Moderate to intense aerobic activity:

• Improves liver insulin sensitivity so the liver responds better to insulin and glucagon.

• Build up slowly. If you’ve been inactive, do not jump straight to HIIT.

• Over time, consider intervals (HIIT or sprint intervals) if appropriate and safe.

Resistance training:

• Start with bodyweight movements, then add load.

• Improves overall glucose control and lowers fasting glucose, reducing strain on alpha cells.

Walk after meals:

• Even 2 minutes helps blunt post-meal spikes.

• 10–15 minutes is great. Do what you can, consistently.

Safety Note on Intense Workouts

• Don’t start with sprints or hard intervals if you’re new or returning from a break.

• Build a base with regular walking and gentle strength work.

• Increase intensity gradually to lower injury risk, especially for older adults.

Why This Works

These same lifestyle tools target several diabetes defects at once:

• Better insulin sensitivity.

• Less liver glucose output.

• Support for beta cells and better alpha cell regulation.

• Steadier fasting and post-meal numbers.

Quick FAQ

• Why is my fasting blood sugar high when I didn’t eat? Alpha cell dysfunction raises glucagon, which tells your liver to release glucose overnight.

• Can this improve? Yes. Food quality, meal composition, walking after meals, aerobic fitness, and resistance training all help. Meds can support this, too.

• Do I need both a GLP-1 RA and a DPP-4 inhibitor? No. They work on the same pathway. Your clinician will pick one based on your situation.

Takeaway

Type 2 diabetes isn’t only “too much sugar” or “not enough insulin.” Alpha cell dysfunction—glucagon gone rogue—is a key piece. The good news: with simple, steady lifestyle steps and the right meds when needed, you can take back control and move toward remission.

If today helped, share it with a friend and subscribe so you don’t miss the next episode. Want expert guidance and a faster path? Reach out to us at [email protected] to learn how we help people put type 2 diabetes into remission—and keep it there.

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The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

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